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Case Name: Case ID: Worker #: North Carolina Residency Declaration County Department of Social Services This form is used to verify that, , is a (Applicant(s) Name) resident of North Carolina and.

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How to fill out the Dma 5152 online

Completing the Dma 5152 form is essential for verifying residency in North Carolina. This guide offers detailed instructions to help you accurately fill out the form online.

Follow the steps to complete your Dma 5152 form with ease.

  1. Press the ‘Get Form’ button to access the Dma 5152 form and open it in the online editor.
  2. In the 'Case Name' field, enter the name relevant to your case. This includes the individual or entity involved in the case.
  3. Next, fill in the 'Case ID' section with the unique identifier for your case. This helps to track and reference your application.
  4. In the 'Worker #' field, input the designated worker number assigned to your case, if applicable.
  5. Proceed to fill in the 'Applicant(s) Name' section with the full name of the individual claiming residency.
  6. Provide the physical address where the applicant resides. Ensure that the details are accurate and complete.
  7. Indicate the residency intention by checking the appropriate box: either 'Intends to reside in North Carolina' or 'Entered the State with a job commitment or seeking employment.'
  8. Sign the form in the designated signature line to affirm that the information provided is true and accurate.
  9. In the 'Relationship' section, specify your relationship to the applicant, which can assist in verifying the residency claim.
  10. Fill in the date of completion in the provided space.
  11. Complete the address and telephone number fields to ensure you can be contacted if necessary.
  12. Once all the fields are filled out accurately, save your changes. You may also choose to download, print, or share the completed form as needed.

Complete your Dma 5152 form online now to ensure your residency verification is processed efficiently.

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For the Standard Plans, active NC Health Choice prior approvals will remain active and transition to NC Medicaid as of April 1, 2023. All other criteria within the prior approval will remain the same, but the health benefit will change to NC Medicaid.

1. A valid North Carolina drivers' license or other identification card issued by the North Carolina Division of Motor Vehicles. 2. A current lease, rent, mortgage payment receipt, or current utility bill in the name of the applicant, showing a North Carolina address.

NC Medicaid Managed Care Health Plans. Behavioral Health I/DD Tailored Plans. EBCI Tribal Option. Health Plan Contracts.

Standard Plans offer some basic behavioral health services. Tailored Plans offer enhanced behavioral health services that are not available in Standard Plans, including Innovations and TBI Waiver services and State-funded services. Additional information is available here.

(1) A valid North Carolina drivers license or other identification card issued by the North Carolina Division of Motor Vehicles. (2) A current North Carolina rent or mortgage payment receipt, or current utility bill in the name of the applicant or the applicant's legal spouse showing a North Carolina address.

Verify eligibility, health plan and primary care provider enrollment using the NCTracks Recipient Eligibility Verification/Response or calling the NCTracks Call Center for more information: 800-688-6696.

Who qualifies for NC Medicaid Direct? Children/youth in foster care. Children/youth who get adoption assistance. Children who get Community Alternatives Program for Children (CAP/C) services. Federally recognized tribal members or others who qualify for services through Indian Health Service (IHS) Former foster care youth.

A Standard Plan is an NC Medicaid health plan that offers integrated physical health, pharmacy, care coordination and basic behavioral health services. NC Medicaid Direct is North Carolina's health care program for Medicaid beneficiaries who are not enrolled in health plans.

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